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Many of us have known for some time that Jane Hamsher  is battling recurrent breast cancer. She's been writing about it on Firedoglake.

I have no doubt that the indignities Jane is enduring are identical to those of tens of millions of Americans who believed if they became ill, their private, for-profit insurance would protect them from financial ruin.

What you're about to see will shock you. It's a chilling and graphic reminder of what an insured patient in the United States faces.

Please note that despite being insured by Blue Cross of California, Jane owes $15,684.94, and I'll bet this is just the tip of the iceberg.

Looking at this bill which is known as the "explanation of benefits" frightens me and it should scare the shit out of you too.

But think for a moment about dear Jane. Imagine receiving this while battling cancer.

Jane is not alone, this Murder By Spreadsheet assault is going on in homes across the length and breadth of our nation.

Now you know about Jane. Jane Hamsher is the face of of but one facet of our American healthcare catastrophe. Jane has insurance.

You might also want to know how hospitals, doctors, the entire healthcare industry in the United States plan on dealing with the medical debt and medical collections crisis which is coming at all of us like a runaway freight train.

I'm convinced that as for-profit insurance becomes more and more worthless--higher deductibles, cost shifting onto your shoulders and mine, the proliferation of high deductible junk insurance, skyrocketing premiums, etc. etc. there's going to be an explosion of medical debt and medical receivables.

I believe this wave of medical debt is going to hit the United States like a tsunami, so I've started to research what may happen.

The the recent acquisition by India’s Mumbai-based FirstSource Solutions  of the U.S. medical billing and collections outsourcer MedAssist Holding for $330 million is worth noting.

MedAssist is a venture-backed firm controlled by Lake Forest, Ill.-based private equity firm RoundTable Healthcare Partners. It provides outsourced revenue-cycle-management services for companies in the health care industry. It also provides eligibility, receivable-management and collections services. MedAssist has more than 1,400 employees.  

I'm in the early stages of looking at this, but I believe the reason this transaction occurred, and many others will likely follow, is because there is an expectation that medical debt will become an immense issue in the near future and cost efficient collection will become a huge necessity and a booming business.

What a tragedy and disgrace. Why is the United States the only civilized industrialized country that considers healthcare a for-profit business?

Why is Dennis Kucinich the only Democratic presidential candidate supporting HR 676? Why are all the others demanding that the American people re-board the Titanic?

Originally posted to nyceve on Sun Sep 02, 2007 at 01:09 PM PDT.

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Comment Preferences

  •  Imagine for one moment . . . (134+ / 0-)
    Recommended by:
    clio, Alumbrados, Angie in WA State, JWC, vicki, eugene, SarahLee, rhfactor, cosbo, TrueBlueMajority, TheGreatLeapForward, GayHillbilly, eeff, yosho, tryptamine, devtob, The Maven, theran, RFK Lives, Norwegian Chef, exNYinTX, LIsoundview, joyous, ReneInOregon, bronte17, conchita, DaleA, Pithy Cherub, roses, javelina, ClickerMel, splashy, Janet Strange, webweaver, oldjohnbrown, Dallasdoc, Caldonia, flatford39, snakelass, lcrp, Liberaljentaps, TheJohnny, barbwires, Noisy Democrat, WV Democrat, vivens fons, julifolo, rapala, madaprn, sarahlane, joanneleon, angrybird, Bluesee, escapee, ghengismom, liberal atheist, el dorado gal, ArchTeryx, Flint, Ranting Roland, LindaR, flubber, zombie, ladybug53, annefrank, blue jersey mom, SheriffBart, lasky57, techno, wiscmass, JanL, danger durden, webranding, begone, debedb, mariva, taracar, mattinla, vigilant meerkat, stonemason, wahineslc, Ellicatt, cookseytalbott, victoria2dc, dewey of the desert, mcartri, isis2, kck, Lashe, ekruegr, OneCrankyDom, bleeding heart, Preston S, feduphoosier, ilyana, Clive all hat no horse Rodeo, Dreaming of Better Days, kurt, Downtowner, Bernie68, eastmt, One Pissed Off Liberal, Noor B, marykk, Cronesense, blue vertigo, moodyinsavannah, Nespolo, kath25, Owllwoman, chigh, terabytes, Calvin Jones and the 13th Apostle, DWG, davehouck, Newzie, pioneer111, madgranny, sable, willb48, TomP, Empower Ink, Fungible Chattel, JDWolverton, Chacounne, galaxy33, Lujane, dewley notid, NogodsnomastersMary, junta0201, chadmichael, demEZ, DK Green, Tennessee Dave

    finishing a grueling and debilitating round of chemotherapy, coming home, taking your mail from the mailbox and opening this notice from Blue Cross of California.

    Just imagine. Frankly, I can't. Or when I do, my heart starts to beat too fast and I feel like I'll become ill.

  •  Thanks for your diary (16+ / 0-)

    Unfortunately this is a daily occurrence in America. One wonders what will happen when housing and medical debt start rising to unprecedented levels. The return of workhouses? A Marge Piercy-style dystopia?

    /there are no rules except discovery /the only tradition is invention. -rachel pollack

    by joseph rainmound on Sun Sep 02, 2007 at 01:17:26 PM PDT

  •  This cannot go on any longer. (33+ / 0-)

    62 years after President Truman introduced a plan is just too damn long.

    On November 19, 1945, only 7 months into his presidency, Harry S. Truman gave a speech to the United States Congress proposing a new national health care program.

    The most controversial aspect of the plan was the proposed national health insurance plan. In the November 19th address, President Truman called for the creation of a national health insurance fund, to be run by the federal government. This fund would be open to all Americans, but would remain optional. Participants would pay monthly fees into the plan, which would cover the cost of any and all medical expenses that arose in a time of need. The government would pay for the cost of services rendered by any doctor who chose to join the program. In addition, the insurance plan would give a cash balance to the policy holder to replace wages lost due to illness or injury.

    Harry S. Truman's health proposals finally came to Congress in the form of a Social Security expansion bill. ...  The American Medical Association (AMA) launched a spirited attack against the bill, capitalizing on fears of Communism in the public mind.  

    The AMA characterized the bill as "socalized medicine", and in a forerunner to the rhetoric of the McCarthy era, called Truman White House staffers "followers of the Moscow party line".

    Organized labor, the main public advocate of the bill, had lost much of it's goodwill from the American people in a series of unpopular strikes. Following the outbreak of the Korean War, President Truman was finally forced to abandon the Bill.

    Truman Library

    Why no plan yet?  Becuase there is big money to be made off the suffereing of Americans.

    "The greatest anti-poverty movement in American history is the organized labor movement." John Edwards

    by TomP on Sun Sep 02, 2007 at 01:18:24 PM PDT

  •  health insurance is out of control (27+ / 0-)

    There was an article by the nation that showed that prices for health care in this country has gone up six times what it was in the nineties while other countries have stayed pretty much the same.  

    Our health care system is broken!  Profit can not be its bottom line over delivering.  Thanks for the diary.

  •  Over $15,000! (7+ / 0-)

    and she has insurance.  This is criminal.  That's the nicest word I could up with for this appalling tragedy.
    This is disgusting.  Shameful and inhumane.

    Bah! Clintobaward will devour all other candidates!

    by o really on Sun Sep 02, 2007 at 01:23:03 PM PDT

  •  It makes me wonder -- (21+ / 0-)

    what's the point? I mean, if you're self-employed or buying coverage out-of-pocket and something catastrophic happens, and suddenly your coverage is a fraction of what you thought it was, might you have been better off just being uninsured in the first place? I mean, aren't a lot of people just blowing all of their money on premiums, money they would never see paid on their behalf if needed?

    I remember having an extended battle with BC/BS of IL, who somehow "couldn't find me" in their system (I call bullshit on that one...) when I was in and out of the ER with migraines. I just didn't open any of the envelopes from them, because I seriously didn't think I could handle seeing what the bills totalled. Luckily, it got worked out, but for too many people, it just doesn't.

    •  yes that's how all insurance works (6+ / 0-)

      they make money by not paying claims

      To sin by silence when they should protest makes cowards of men~~ Abraham Lincoln

      by Tanya on Sun Sep 02, 2007 at 01:39:12 PM PDT

      [ Parent ]

      •  Yes, but -- (2+ / 0-)
        Recommended by:
        TrueBlueMajority, snakelass

        I mean literally, there must be some people who pay all that money in premiums, who then need to have the insurance pay for something, which the insurance then will not pay for. Arguably, the money they wasted on premiums might be less than what the insurance now refuses to pay. So even just paying the premiums can be a lose-lose situation.

        •  exactly, which is why when I was younger and (5+ / 0-)

          healthier and didn't get ins. from a job, I was uninsured. It was cheaper to just pay for office visits and perscriptions. it never came close to what the premiums alone would have cost.

          To sin by silence when they should protest makes cowards of men~~ Abraham Lincoln

          by Tanya on Sun Sep 02, 2007 at 01:47:32 PM PDT

          [ Parent ]

          •  And that (12+ / 0-)

            can work for many young, healthy people. But god forbid anything catastrophic happen, like a freak accident...

            •  See That Is It (17+ / 0-)

              Tucker said the other day that people under 30 really don't need health care. At some level I can see what he is saying about men like myself. But women, well that is another issue.

              I work out 3-4 times a week. I don't have any chips or candy in my house. I don't recall the last time I had a soda. And my fridge is pretty much all fruit and veggies.

              But I almost died one day. And at that time I was young and healthy. And it wasn't a wreck. It was a major health issue that happened almost overnight. You know they can happen that way.

              And as I say in another post I am still paying the expenses off (and I had insurance) five years later. Being in the ICU for nine days is really expensive.

              "It is not enough to win, all others must lose," Sun Tzu.

              by webranding on Sun Sep 02, 2007 at 01:55:07 PM PDT

              [ Parent ]

            •  Just because you are young and healthy (0+ / 0-)

              doesn't mean you'll stay that way.  As another poster said, "freak accident."  My 12 year old, extremely healthy daughter had a very serious freak accident last year.  Her total medical bill was around $75,000.  The ambulance ride from school to the hospital was $800.  The Life Flight from the first hospital to the Medical Center, when they determined she needed trauma care, was $9,000.  Then add in a bunch of surgeons and a week's stay in the hospital, and you are pretty much bankrupted if you don't have insurance.

              And yes, luckily, we had insurance.  But to reinforce another point, how in the hell is anyone supposed to do price comparisons on their medical care in situations like this?  When your kid has life-threatening internal injuries, you are not about to call around for a cheaper Life Flight chopper.  Get her to the best hospital, get her stitched up, and worry about the bills later.  The whole idea is ludicrous.  Maybe you should price shop for your breast implant surgeon, but otherwise, forget it!

          •  This is why we need universal single payer. We (21+ / 0-)

            need to have everyone in the pool, not just the oldest and sickest among us. Also, high quality preventive care (and there is not as much money to be made in this) can allow us to avoid many chronic diseases. Our life expectancy is much shorter than the life expectancies of many other industrialized countries.

          •  Yes but,... (5+ / 0-)

            There have been many articles exposing the fact that most medical facilities give cost breaks to the insurance company that they don't give to the uninsured. So in some cases, procedures can be 3-4 times more expensive if you are uninsured. This is the part that really upsets me. It makes it hard to do a reasonable cost-benefit analysis of whether it's worth it to pay the premiums.

            I beg to dream and differ from the hollow lies..

            by lesliet on Sun Sep 02, 2007 at 02:13:58 PM PDT

            [ Parent ]

            •  That's true but you can also negotiate with the (1+ / 0-)
              Recommended by:
              blue vertigo

              Hospitals and doctors. Just liike banks they would rather get something rather than nothing, but I'm not sure how the new bankruptcy bill effects this. Most people don't know this so they just pay the full bill. You can also work out very very low payment plans. At least this is true in my state I'm not sure how other states work.

              To sin by silence when they should protest makes cowards of men~~ Abraham Lincoln

              by Tanya on Sun Sep 02, 2007 at 02:22:29 PM PDT

              [ Parent ]

              •  You Can't Negotiate With Doctors And Hospitals (7+ / 0-)

                Negotiation implies that both parties have some kind of leverage on each other.  

                The doctors and hospitals have treated you.  They have sent a bill.  They have every right to collect the bill in full.  Bankruptcy reform removes your leverage.  Used to be you could file Chapter 7 and wipe them out.  "Take 20% or I'll file!"

                Not anymore.  Now, you pay, or they file suit and get a judgment, and it sits there for 20 years, collecting interest, until you pay it off.  Wage garnishments, property levies - oh, the fucking people are going to get at the hands of collection agencies.  

                This makes subprime mortgages look like nothing.  Not everybody has a mortgage.  But everybody can get sick.  

                •  very true but like I said every state is differen (1+ / 0-)
                  Recommended by:

                  and not all providers are monsters. many will still allow you to negotiate the price and the payment plan can be very low.

                  To sin by silence when they should protest makes cowards of men~~ Abraham Lincoln

                  by Tanya on Sun Sep 02, 2007 at 03:46:31 PM PDT

                  [ Parent ]

                •  What you get in the mail (1+ / 0-)
                  Recommended by:

                  is an account stated. It really says we are prepared to get paid these amounts.

                  You can compare what you are charged on tests with the amount Medicare pays.

                  If Medicare pays $14 for a test and you are charged $60, you write back that you appear to be have overcharged three-fold.

                  Medicare test price list for January 2006:
                  [The Notepad file has prices I believe, the Excel file maybe]

                  Oregon Health Plan provider price list:

                  Oregon Health Plan drug list:

                  Maryland hospital rates I believe Excel (I can't open the files):

                  If the hospital takes state, local government, or Medicare patients the facility should be legally bound by state 14th Amendment protections to not charge you more. Ask the billing office for the amount Medicare would pay. If you can pay it, about 1.3 times that amount would be a pretty fair amount to pay.

                  If the hospital takes Medicaid patients, you should also be entitled to Medicaid per diems. If they will not be reasonable, they may be forced to accept these very low amounts.

                  In Florida, the workman's comp program sets hospital rates. Floridians should be able to get them in Florida under the 14th Amendment.

                  •  14th amendment? (0+ / 0-)

                    Huh?  What does the 14th amendment have to do with what a private hospital charges you?  

                    I'm not closing my mind to the theory - just wondering what it is.  

                    •  The state government protects (1+ / 0-)
                      Recommended by:

                      its employees against excessive charges.

                      The local government protects its employees against excessive charges.

                      The Federal government protects people over 65, the disabled, many children, and the poor against excessive charges.

                      The 14th Amendment states:

                      No state shall...deny to any person within its jurisdiction the equal protection of the law.

                      Note the use of the term "the law" as opposed to its law.

                      •  Sorry, SingleVoter (0+ / 0-)

                        Equal protection means that the government can't treat some people differently than others without at least a rational basis for its actions.  Nothing in the Constitution requires private corporations to provide Constitutional rights.  

                        And we are dealing with guys who believe that "equal protection" means that the rich and poor are equally free to sleep under bridges.  

                        •  Don't expect a court (0+ / 0-)

                          to order the sheriff to drag a black or Jewish person out of a private development.

                        •  The equal protection (0+ / 0-)

                          clause is why I believe Bush is pushing 100% private insurance.

                          Any time there is state-paid Medicaid or SCHIP claims or public employees with government contracted coverage, equal protection arguments can be made.

                          In many states including mine last year, state-paid Medicaid claims have phased out in favor of private insurance. I believe the reason they are willing to pay for the overhead of private insurance is because it reduces the equal protection claims the 47 million not regularly fleeced uninsured could make from the Medicaid rate to the insurance rate.

                    •  The private hospital would (0+ / 0-)

                      eventually have to turn to a state court to try to collect money.

                    •  Many private developments (0+ / 0-)

                      used to have covenants denying Jews and blacks residence.

                •  When I was uninsured and unemployed and (0+ / 0-)

                  had emergency gall bladder surgery, I got $23000 worth of bills.

                  I negotiated them all down and paid them out.

              •  And also, not what you want to deal with... (4+ / 0-)
                Recommended by:
                TrueBlueMajority, nyceve, Tanya, Noor B

                ... when you're sick. I had a brush with breast cancer 6 years ago (I'm okay now). It's hard to describe how facing something like cancer can do a number on the logical and analytical part of your brain. Every little annoyance in life becomes a major crisis. I know that at one point after my major treatment was over, I was forced to switch insurance plans due to a change in employment, and just the prospect of having to change doctors was terrifying to me. I could not imagine dealing with something like trying to negotiate with a health care facility to reduce the cost of treatment at a time like that.

                I am lucky to live in Massachusetts, where you can't be refused insurance for pre-existing conditions and the insurance plan (HMO plan) I had at the time of my breast cancer provided very complete coverage with only minor co-payments.

                PS: I noticed that on Jane's bill, part of the reason for the high costs to her is that she appears to have used out-of-network facilities. I've had insurance in the past that distinguished between in-network and out-of-network providers, and I've always stayed in-network to be sure I was covered. These bureaucratic distinctions are annoying, but it is something to pay attention to as a survival tactic when dealing with these companies.

                I beg to dream and differ from the hollow lies..

                by lesliet on Sun Sep 02, 2007 at 03:23:43 PM PDT

                [ Parent ]

                •  Yeah, but if you're dealing with recurrent (3+ / 0-)
                  Recommended by:
                  SarahLee, nyceve, barbwires

                  cancer, you want the best doctor in the field, not just the best one on the list.  Otherwise, it seems to me that you're rolling the dice more often than you should in that situation.

                  "Fighting Fascism is Always Cool." -- Amsterdam Weekly, volume three, issue 18 (-8.50, -7.23)

                  by Noor B on Sun Sep 02, 2007 at 03:58:01 PM PDT

                  [ Parent ]

        •  Talk To The Folks In New Orleans (4+ / 0-)
          Recommended by:
          mcartri, Noor B, kath25, chigh

          the same thing is happen not only in health care.

          "It is not enough to win, all others must lose," Sun Tzu.

          by webranding on Sun Sep 02, 2007 at 01:50:29 PM PDT

          [ Parent ]

          •  Absolutely. (7+ / 0-)

            And whether it's the Feds or the private insurance companies, it's the same thing.

            A fellow Kossack who works in the insurance company and I were discussing the recent flooding down here in Austin, and this person noted that homeowner insurance is just being extended to fewer and fewer people, and often at much higher rates. These people are then forced to turn to the government for insurance and/or disaster relief, neither of which may be available either. It's an interesting and scary intersection of the crumbling of our social safety net and humans' increasing destruction of our planet.

    •  That's one reason I am currently uninsured (2+ / 0-)
      Recommended by:
      SarahLee, kath25

      I'll be damned if I pay them money to screw around with me.

      I'm not part of a redneck agenda - Green Day

      by eugene on Sun Sep 02, 2007 at 02:54:11 PM PDT

      [ Parent ]

  •  Nothing Short of Disgraceful (15+ / 0-)

    Clearly, as we saw from your diary yesterday, Jane's insurance problems could be solved if she were to switch jobs with Tony Snow.  That our government gives its own employees coverage that essentially far exceeds that of any private insurance plan, yet is unwilling to work toward extending that level of coverage to the entire population, is a demonstration of the bankruptcy of our system.

    What part of "government . . . for the people" do they not understand?

    •  OMG I Am Going To Quote Huckabee (5+ / 0-)
      Recommended by:
      SarahLee, DaleA, ladybug53, Tanya, drmah

      Say what you will about the guy. I don't like a lot of his points (ok most), but two things I like are his stance on:

      (1) Health. I am 38 and 5'4. Used to weight 210. I now weight 132. Many in my family are closer to the 210. It is better to spend a little and keep people healthy then pay if they are not.

      (2) I've heard him say it before and he said it again today, "Every American ought to have the health care plan that those in Congress have or those in Congress ought to have the plans that the average American has."

      It may be the wrong person to care that second message. But gosh it is a powerful message.

      "It is not enough to win, all others must lose," Sun Tzu.

      by webranding on Sun Sep 02, 2007 at 01:36:42 PM PDT

      [ Parent ]

      •  Sorry webranding, please forgive what I'm . . . (3+ / 0-)
        Recommended by:
        webranding, isis2, DWG

        about to write.

        Huckabee, are you kidding me? NO. Fucking. Way.

        I don't care what he's saying. It's a lovely message, you think he'll do a damn thing about healthcare, not on your life.

        •  I Am Not Sure To Be Honest (1+ / 0-)
          Recommended by:

          On the right or the left there are few people I trust. And by trust I don't mean they agree with me, but that I think they mean what they say. Huckabee falls into that group for me. I would never vote for the guy, but I think he means what he says.

          And to my second point. Not sure if he'd do or could do anything. But it is a darn powerful message. Wish my guy, Edwards, would have thought of it.

          "It is not enough to win, all others must lose," Sun Tzu.

          by webranding on Sun Sep 02, 2007 at 01:42:52 PM PDT

          [ Parent ]

          •  Good message, but (2+ / 0-)
            Recommended by:
            nyceve, barbwires

            It is easier to keep people healthy than fix health problems.  It is a good message, but I resent the idea that if you are not healthy it is somehow your fault.  If he had a heart attack before he became a runner and lost the weight, then he would want good care to restore his health.  And yes, every American should a plan to rival that of the critters in congress but at a cost they can afford.  He proposes no solution to go with his talking points.  The reality is that people get sick, cannot afford coverage, or cannot afford uncovered costs.  Wishful thinking and promises the free market or health insurance scum will solve the problem are meaningless.  

            A tyrant must put on the appearance of uncommon devotion to religion. - Aristotle

            by DWG on Sun Sep 02, 2007 at 02:25:31 PM PDT

            [ Parent ]

      •  Outside of Washington, DC (0+ / 0-)

        and Denver, CO, there are probably a very limited number of acceptable plans.

        I doubt the postal workers plan would like Joe Six-Pack et al. dragging up the rates charged to the hard-working and generally very healthy postal workers.

    •  Tony Snow quit (2+ / 0-)
      Recommended by:
      SarahLee, TrueBlueMajority

      his job because $168,000 a year wasn't enough.

      That's what he said at least. But yeah, he had hella good insurance and bless his heart, had to use it a lot.

  •  eve I know this is a little off topic (7+ / 0-)

    and that your diaries focus on the insurance industry, but I think it would be really helpful if you did a diary about the roll both hospitals and some doctors play in the current healthcare crisis. Having represented healthcare workers since way back in the day of fee for service payments, I have witnessed the crumbling system from the inside out. People really need to understand how healthcare works in this country, what drives up cost and at the same time reduces services. It is all of these components that will help to create the understanding as to why a single payer regulated system is the only thing that will fix the system.

    To sin by silence when they should protest makes cowards of men~~ Abraham Lincoln

    by Tanya on Sun Sep 02, 2007 at 01:37:31 PM PDT

  •  Medical costs are already a huge isse (4+ / 0-)
    Recommended by:
    tryptamine, nyceve, blue vertigo, DWG

    Medicaid and Medicare are expected to go bankrupt long before Social Security. I don't know how, knowing this, the government can continue to say they do not need to intervene when it comes to controlling costs.

  •  Meet Cranky, He's Dying of Cancer (33+ / 0-)

    because Medicare wouldn't approve the test that could of saved his life until it was too late to do any good. There are hundreds of thousands of us out there. This is Class Warfare. Instead of paying for the tests and treatments, now all they have to pay for are the pain meds and maybe hospice in the last month or 2. I'm willing to bet they saved a couple hundred thousand dollars that way that they can spend on building the War Machine for Iraq and Iran. It's nice to know I'm dying for such a great fucking cause....

    -8.63 -7.28 Ask " The Question "

    by OneCrankyDom on Sun Sep 02, 2007 at 01:46:00 PM PDT

    •  Thoughts and prayers, Cranky (8+ / 0-)

      I cannot begin to express my sorrow at your suffering.

      A tyrant must put on the appearance of uncommon devotion to religion. - Aristotle

      by DWG on Sun Sep 02, 2007 at 02:28:38 PM PDT

      [ Parent ]

      •  Thank you both, but no sorrow or pity please (10+ / 0-)

        I tell this story so others can carry on the battle after I'm gone. I'm a strange bird, I have never feared death, in fact I welcome it somewhat and alway have. I want people to know what is happening in the real world.

        I see so many people say things like " MediCare for all", and wish they would do their own research before making such dumb statements. Medicare is not the cureall, it is part of the problem. I knew a couple that had been married 42yrs that had to get divorced so the wife could get Medicare and then treatment because if they stayed together they would of had to lose their home and the business they had spent their lives working for. It ended up with her dying anyway, and he followed shortly after of sorrow and the guilt he felt over the divorce even tho it was the best thing he could of done for her.

        Medicare does get anyone great quality care except on the rare occasion that they find the rare Dr. Our own Dr., who heads a local county clinic here is leaving to go into private practice and he will not be accepting Medicare patients because of what they pay the Dr.s. He has told us we are 2 of 10 of the patients he will keep, but only because we have become good friends and he knows neither of us will be around more than a yr or 2, in my wifes case.

        Don't mourn for me, please spend that energy working to save those that still have a chance at a full life.

        -8.63 -7.28 Ask " The Question "

        by OneCrankyDom on Sun Sep 02, 2007 at 02:54:35 PM PDT

        [ Parent ]

    •  Cranky, if you want to send me an . . . (6+ / 0-)

      email describing how Medicare fucked with you, I'd be honored to write about you and your terrible situation in a diary.

      Do you have traditional Medicare or Medicare Advantage?

      •  Thanks eve (0+ / 0-)

        I flip flop constantly on if I should even talk about me and what is going on. The above post and the one in your last diary was done in a moments of self-pity and anger, and for the most part I regret even writing them.
        My story is not a new one, it happens to many people daily. I'm a MediCare/MediCal and live in a very small town with limited faciltys. Some tests and procedures require approval before they can be scheduled, and that includes the travel expenses and hotel bills since I was force to travel for testing. Between being turned down for "unnecessary" tests, lost paperwork that had to be resubmitted a couple times, the fight to get the approval and then the ancillary stuff, plus a long lead time, it took a little over a yr to put it all together. Brain tumors continue grow during that time and finally reach a point where they can become too big or wide-spread to be operated on. I've been told many times by people in the know that my case is in no way unusual tho rarer in Ca. than in some places like Appalachia country.

        The actual travel, while a relatively short distance of less than 60 miles one way, took moving major mountains since I can't drive anymore,there is no service short of a ambulance,  and the ambulance services wont do that transport because of low and slow pay by Medi/Medi. Living on a low fixed income made other options unexistant, not to mention I had to find and pay for a caregiver to stay with my SO while I was away. Those 2 things alone took a couple months to work out one the tests were finally approved in Santa Barbara.

        One of the most discouraging parts of the whole deal was I could of had the tests done here in town, but the facility here would not accept my ins. because of what the ins. pays for the tests. Even stranger is that the place I went to in SB is part of the place here that turned me down. They claimed they couldn't do the "right kind of billing process locally", so it had to be done down south. I believe more than anything it was a greed, sloth, clerks making medical decisions, Medicares low pay, a few major mistakes in the documentation, just plain bad luck, and finally the price of being poor.

        It's really not much of a story in that it a common story, told by probably millions over the yrs. Eve, your time is better spent doing the work you do every day rather than putting any focus on me. As you and I have discussed in emails, I'd prefer that I not become the story since there are many more important issues to be discussed. Please just keep up your good works and take care of yourself so you don't burnout or become ill yourself. Your heart is as big as any persons I have ever met and you are in my prayers.

        -8.63 -7.28 Ask " The Question "

        by OneCrankyDom on Mon Sep 03, 2007 at 04:10:04 AM PDT

        [ Parent ]

    •  I'm so sorry, friend. (2+ / 0-)
      Recommended by:
      SarahLee, TrueBlueMajority

      Can we here on DK help you in any way?

  •  Eve, I've been dealing with insurance issues (5+ / 0-)

    myself for years and for that reason I really appreciate your diaries on these issues.  Keep up the good work.

  •  Jane Went 'Out of Network' (1+ / 1-)
    Recommended by:
    Hidden by:
    Trust me, I hate the insurance companies with a passion, however this case is Jane's fault, not Blue Cross's.

    This $15,000+ bill is because Jane used a doctor(s) who are not part of Blue Cross's contracted network.  Had she used contracted doctors she wouldn't owe anything beyond her $2,500 deductable and her maximum annual out of pocket (which she has already reached).

    •  Fault? (9+ / 0-)

      I'd want to see what doctors were in-network, what their success rates are and what the waiting time for her surgery would have been before I'd say it was her fault for going out of network.

      But, yes, out of network costs a lot more.

      I recently had some surgery, and part of the decision about surgeons was who is and is not in the network.

      (-7.38,-2.51) 76% of dKos readers think I'm a secret wing-nut operative!

      by Gustavo on Sun Sep 02, 2007 at 02:45:15 PM PDT

      [ Parent ]

      •  BC has a pretty extensive network, however... (0+ / 0-)
        BC has a pretty extensive, high quality, very well educated(from America's elite medical schools) network, however I know from direct knowledge that some of the elite practitioners at St. Johns in Santa Monica do not contract with HMOs/PPOs.  "Fault" is perhaps an incorrect word -- my issue here is Jane made a choice that she should've known would cost her more out of pocket and is now incorrectly blaming BC in a highly publicized way.
        •  One could argue (2+ / 0-)
          Recommended by:
          churchylafemme, Noor B

          That BC made it impossible for certain docs to contract with PPO's.  Their allowed charges were just too low.

        •  Hey Dr. Frist (9+ / 0-)

          Since I've never publicly said exactly what I had to have done, most people wouldn't have any way of knowing what doctor was qualified to do it or whether they were "in network" or not.  I also didn't mention that I was treated at St. John's in that post.  You're pretty amazing.

          But as long as I've got you, I have this little pain in my right hip, it's been bugging me and it won't go away.  It's baffled everyone else.  Can you tell me what it is?  

          •  Jane... (2+ / 0-)
            Recommended by:
            David Boyle, barbwires

            Respectfully, you're correct, I don't know exactly what you had done beyond what was available on the Internets (at FDL and Digby's), which if I'm not mistaken included the fact that you were at St. Johns. If I'm wrong, I stand corrected.

            Secondly, I mentioned St. Johns because I have some direct knowledge looking for specialists there. Additionally, I have friends inside the practice of a specialist in Santa Monica and have some general inside knowledge of the medical community there.

            Finally, all of that is beside the point.  You have the right in your PPO to see any doctor you wish, with payment to be made according to your contract. If you knew your doctor had left the network you could've, can, should seek to negotiate with either the doctor and/or the PPO to discount to the contracted rate. If, indeed, there are no in-network doctors qualified to do your proceedure you would and do have an excellent case for a referral out of network without additional cost to you.

            •  What, is she buying a car??? (4+ / 0-)

              If you knew your doctor had left the network you could've, can, should seek to negotiate with either the doctor and/or the PPO to discount to the contracted rate.

              What a nice little metaphor for our system.  Someone with cancer is supposed to negotiate the price of her treatment with her physician or insurance company prior to treatment, and if she doesn't get the best possible deal before permitting them to treat her, well, too bad about that bill.  You should have gotten a better deal.

              This is not somebody who bought a used car for a just-this-side-of-usury interest rate who should have gotten up and walked out of the dealership.  This is a person with a life threatening illness trying to get better.  

              •  Steve, Fungible Chattel says it very well (3+ / 0-)
                Recommended by:
                SarahLee, RAST, churchylafemme

                The problem with our system is exactly that it requires patients diagnosed with potentially fatal illness to approach their doctors as though they were car salesmen. What kind of model is that for health care?

                Even if you are very sharp and extremely self-disciplined, it is hard to remain detached enough to handle the problem of getting health care for a potentially fatal illness with that much objectivity. What about the millions of Americans who are not well-educated about health care choices and who cannot detach emotionally from their situation in order to bargain for the best possible financial deal? And then there is the issue of time. How to balance the risk of taking time to bargain  against the need for treatment as soon as possible?

                There is simply no justification for keeping this kind of profit-oriented system going.

                Fox News--We distort; you watch, self-satisfied. We misreport; you witness liberticide. We sport with truth; liberals apply vermicide.

                by Cowalker on Sun Sep 02, 2007 at 07:35:16 PM PDT

                [ Parent ]

              •  It's a hard and stressful time, but ideally yes (1+ / 0-)
                Recommended by:
                Steve in Sacto

                Assuming that it isn't an emergency situation, then the patient (or someone the patient trusts) should ask the doctor about continuing treatment at a discounted rate, because it is a recurrsnt problem, and keeping continuity of care is important. The doctor's practice may be able to offer discounts to existing patients.

                Failing that, get the original doctor to come up with an in-network referral.

                And then the patient meets the new doctor, and makes an instinctive choice whether to continue care with the old doctor (at a higher cost) or the new doctor.

                If the insurance company had any responsibility to its customers, it would have a patient advocate who could make the phone calls to the existing doctor's practice, ask about lesser rates, set up the in-network referral and such. But they don't, so the patient needs to do it all themself.

                It completely sucks that you do have to navigate a very complicated insurance system while handling an illness at the same time, but (at least until we have universal health care) you have to. Often it's best to get a close friend or fsmily member to help navigste the insurance tangle.

                It's a complete mess: you have to get the best care possible, while still minimizing out of pocket expenses so that if (god forbid) this crisis is followed by another crisis, you have the cash on hand to maximize your options in that crisis.

                It helps if you're a sociopath (I am pleased to discover that in times of crisis, I have no emotions -- works out well for me, although it seems to scare my loved ones a bit).

                This is not meant to criticize Jane. I don't know what Jane's situation is, whether she had the time to do this, or either the ability to do this herself, or the people around her who can do all of this for her, or even whether she did all that and decided to stick with the current doctor (not a crazy choice).

                I'm very glad to read above that Jane is in a financial state where she can make the choice to go with her current doctor. It's a "luxury" a lot of people wouldn't have, and I think that should have been a focus of the "Meet Jane..." diary.

                (-7.38,-2.51) 76% of dKos readers think I'm a secret wing-nut operative!

                by Gustavo on Sun Sep 02, 2007 at 08:05:09 PM PDT

                [ Parent ]

              •  Let me add... (0+ / 0-)

                FC, Gustavo addressed your points well. To be clear, in no way am I endorsing the current state of affairs.

                Let me just add that as health insurance goes Jane's PPO is actually one of the better plans.  Unlike an HMO, where she would be channelled into one medical group and through a primary care doctor, Jane had the choice -- in network -- to directly see any number top specialists at any of the premier hospitals in LA (including UCLA medical, St. Johns, Cedars-Sinai etc.). Beyond that, she also had the choice -- and it was a choice -- to see (or stay with) any doctor she wanted outside the network and pay the difference.

                Any number of insured people (let alone the uninsured) stuck in shitty HMOs would love to have the freedom and options that Jane had in network in her PPO. Her complaints about having to pay extra for her additional freedom to see any doctor is hardly the best example of our fucked up system.

      •  That is what burns me about (0+ / 0-)

        the Rush Limbaugh, et al. BS about Universal Health Care being socialized medicine where you can't pick your doctor and have long wait times - Like we DON'T ALREADY have that now?  We just get to pay more for the "inconveniences."  

    •  I am near Jane in what I owe Hospitals (12+ / 0-)

      and I am telling you that you have no idea what you are talking about.  I have been in and out of Hospital and had 6 major surgeries including brain surgery. If you are sick with an ongoing illness like cancer or an autoammunine disease, you run up bills that insurance co. don't pay.

      "Though the Mills of the Gods grind slowly,Yet they grind exceeding small."

      by Owllwoman on Sun Sep 02, 2007 at 03:19:45 PM PDT

      [ Parent ]

    •  Excuse me Steve . . . (12+ / 0-)

      You damn straight she went out of network. And you might go out of network too if you had recurrent prostate cancer!

      When you have a PPO and you go out of network, the fucking criminal insurance company is supposed to pay 80% of the usual and customary charge up to a certain amount, then 100%.

      You are only supposed to go out of pocket up to a defined cap.

      •  BC has a really crappy "usual and customary" (7+ / 0-)

        Well, it's true.

        Which means that when you hit the cap, and they start paying 100% out of network, it's 100% of crappy "usual and customary", which is below the amount the doctors actually charge.

        Learned this during my orientation for a new job where the helpful HR people were explaining the differences between health plans.

        (-7.38,-2.51) 76% of dKos readers think I'm a secret wing-nut operative!

        by Gustavo on Sun Sep 02, 2007 at 03:27:16 PM PDT

        [ Parent ]

        •  Exactly. They don't pay the whole Drs. bills or (6+ / 0-)

          Hospital bills. They pay what they think a Dr. or Hospital should charge. And the Docs. and Hospitals kindly send you the bill for the remainder. Also you have to go over bills with a fine tooth comb because they add things you never recieve.

          "Though the Mills of the Gods grind slowly,Yet they grind exceeding small."

          by Owllwoman on Sun Sep 02, 2007 at 03:42:41 PM PDT

          [ Parent ]

          •  But this is normal for all insurances, not just (0+ / 0-)

            BC/BS. When you go to the doctor for a visit--let's say for an OB/GYN pap smear--the charge may be $500. BC/BS will pay maybe $100, making you pay your deductible and coinsurance rate. That would be maybe $50 (based on the 90/10 split) and the $10 copayment. The doctor would be out of luck on the remaining $340.

        •  The UCRs (2+ / 0-)
          Recommended by:
          SarahLee, churchylafemme

          are total screwovers.  Plus the fact even "in-network" can leave out some important folks, like the anaesthesiologists.  Some years ago I had heart surgery--the hospital was "participating," the surgeon was, but none of the anasthesiologists were, and I'm sorry, but I wasn't about to have open heart without one.  Just not that tough.  After insurance paid the "UCR," my share of the costs for anaesthesia was about 10K.  Above and beyond the deductible.

          Democrats give you the Bill of Rights; Republicans sell you a bill of goods!

          by barbwires on Sun Sep 02, 2007 at 06:14:40 PM PDT

          [ Parent ]

        •  Not just Blue Cross, but they're really bad (3+ / 0-)
          Recommended by:
          SarahLee, churchylafemme, gkn

          I was nearly driven into bankruptcy when my spouse got cancer and they refused to pay more than 'reasonable and customary' on the oncology treatments (radiation and chemo).

          No onco unit within 6 hours' drive of my home would take their payment in full -- which at BEST was only 60% of the billed amount.

          And so at the end of it, we found ourselves over $55k in debt.

          When I complained to the claims people at BC, they said, "It's not our job to help you find a doctor or oncologist."


          •  So how did you get out (0+ / 0-)

            of debt?

            •  Paid and paid and paid for years (0+ / 0-)

              Wasn't far from a form of 'indentured servitude' as mentioned in other comments in this thread.

              Wasn't just $55k -- there was also interest accruing.

              My entire life, I felt ill-used by the fraud of 'health insurance'.  It never paid what the policy said it would.  To get payments, I almost always had to fight for them.  And for certain treatments -- the ones that most impacted the quality of my life, including LASIK eye surgery -- I had to pay some or usually all of the cost.

              The first healthcare system I actually appreciated and liked is the one where I'm living now in India.  No insurance -- but every treatment I can imagine is AFFORDABLE.

      •  Sorry, but... (2+ / 0-)
        Recommended by:
        TrueBlueMajority, nyceve

        As to your first point, Jane stated just above that she's been with the same provider throughout, so this isn't an issue of going out of network to find new advice on a recurrent problem.

        As to your second point, the fucking criminal insurance company (agreed) actually makes it more prohibitive than 80/20 to go out of network -- it's usually closer to 50/50. It sucks, no question, but it shouldn't have been unknown either.

    •  Victim blaming? (1+ / 0-)
      Recommended by:

      Shame on you.

    •  Why (2+ / 0-)
      Recommended by:
      SarahLee, churchylafemme

      do we even have an insurance system that has "in-network" and "out-of-network" physicians?  This is one part of the larger problem with the for-profit system that we have in this country.  Jane (or anyone else for that matter) should have the right to see whatever physician s/he wants to without worrying whether that physician is "in" or "out" of an insurance company's network.

      Build bridges not fences.

      by sable on Sun Sep 02, 2007 at 09:21:37 PM PDT

      [ Parent ]

  •  Check out this cartoon on dhonig's (1+ / 0-)
    Recommended by:

    Friday cartoon round-up. Scroll down to Free Market Emergency?

  •  Original tags: (3+ / 0-)
    Recommended by:
    SarahLee, nyceve, Pithy Cherub

    cancer, health care, for-profit insurance, single-payer, Recommended

    I edited to:

    cancer, health care, health insurance, single payer health insurance, Recommended

  •  We've got to get these stories out there (8+ / 0-)

    Support for single-payer has risen dramatically in California over the last year. People are beginning to realize that having insurance will not save them.

    I believe that's what sank the '90s round of reform efforts - folks felt "well I have insurance, I'm OK, I don't want to rock the boat to help some jobless sap." Now, as the system collapses around them, they see that insurance no longer works for anyone, and folks become more open to single-payer as a solution.

    I'm not part of a redneck agenda - Green Day

    by eugene on Sun Sep 02, 2007 at 03:00:31 PM PDT

  •  Face it, Bush takes better care of the Insurance (4+ / 0-)

    Industry than he does the American People.

    "Though the Mills of the Gods grind slowly,Yet they grind exceeding small."

    by Owllwoman on Sun Sep 02, 2007 at 03:14:58 PM PDT

  •  CapitalOne Health Care Financing (8+ / 0-)

    When I was at the dentist I noticed these brochuresfor
    "financing" your health care expenses. Granted this was for dental and vision, but where will it end? I think this is just the camel's nose under the tent.

    Murder by spreadsheet seems more like rape and pillage if you ask me.

    •  Yup...I had to use it last year (4+ / 0-)

      It's a credit card...called CARE CREDIT.

      Dental Insurance SUCKS.
      I am, at 61, at the age where all those silver fillings have been cracking.  Sometimes if your lucky it doesn't crack what's left of your tooth and you don't need a root canal. I had about four of those.  So when a few more started cracking, the dentist recommended I get them all fixed ASAP to avoid the root canal and make it  easier and in the long run cheaper.  
      My insurance tops out at a fixed sum per year per caps.....and I needed five.  So I could wait and hope my teeth would hang on for another 8 months.  

      I decided to go for it.  I had to pay $1900 out of pocket.  So I used the credit card.  The good part is that if you pay within a year you don't pay interest.  So I made it.....

      Between what insurance paid and what I paid it was $3400.   I don't want to lose my teeth so I want to take care of them. Fortunately, I can ....with saving and working and insurance.  But I am sure there are many people who put off dental work because of costs and sadly in the long run it costs money and in health.

      •  I had to use Care Credit (1+ / 0-)
        Recommended by:

        For 2 crowns and some other minor work.  After my regular dental insurance, I was left with over $1500 in bills.  

        I paid it off within the year, but that last payment was made just under the wire.  If you don't pay the last $1 before it's all due, you get charged all the interest for the entire year, even if you're just $1 off.


        "Strange women lying in ponds distributing swords is no basis for a system of government!"

        by ClickerMel on Sun Sep 02, 2007 at 09:54:07 PM PDT

        [ Parent ]

  •  Sounds awful. (4+ / 0-)
    Recommended by:
    SarahLee, nyceve, Noor B, blue vertigo

    Glad I moved to Europe.

    People who do emigrate should remember to vote though:

    US Citizen Overseas? REGISTER TO VOTE ALREADY!

    by kevin lyda on Sun Sep 02, 2007 at 03:21:58 PM PDT

  •  As a counter example, I've just been diagnosed (12+ / 0-)

    with cancer, but I'm an expat American living (and paying taxes) in Canada.  With my income I wouldn't have ANY coverage in the U.S., but here it's been a different story.

    At the first hint of something being amiss, I rang the toll-free number to speak to a nurse, to ask if I ought to head for emergency or wait until the next Monday to see my GP.  She recommended emergency.  

    Cost: $0

    In the emergency, they tested for and diagnosed an infection, gave me some anti-biotics, and strongly urged that I see my GP and book a cystoscopy asap.

    Cost: $0

    I got in to see my G.P. early the following week; he simply booked my appointment with a specialist, and sent me for blood and urine work.  No questions asked about coverage.

    Cost: $0

    The urologist also sent me for a round of tests, including ultrasound, without hesitating over whether I could afford it or not.

    Cost: $0

    Surgery is coming up soon, and because we found it early, which we did because I did not have to budget a visit to a doctor, but could go at the first symptom, it's going to be a relatie piece of cake.  The tumour is so small that the ultrasound missed it, even while looking for it in precisely that location.

    Cost: $0

    As a result, I'm going to live through this (barring some bizarre turn of events), and will not be battling with and against protracted chemo or radiation.

    I'll be able to watch my daughter graduate from high school, go on to university, and maybe play with grandchildren in the not TOO distant future.


    •  Good luck from a cancer sister! (7+ / 0-)

      I'm so sorry to hear about your diagnosis.  It's great to hear that you won't have to worry about how to pay for care, or whether you can get care in a timely manner.

      Good luck with your upcoming surgery (you'll keep us posted, I hope?).  We'll all be thinking good thoughts for you!

      I have a chronic leukemia and have so-called "good" insurance here in the U.S., but the deductibles, co-pays, and excluded costs are staggering: so far, more than $5,000 out of pocket for the past two months alone.  In the past, sometimes the costs caused me to skip appointments or postpone them to after payday, though I can manage things alright this year.  I wonder if there's a way to learn how many people's cancers are not diagnosed promptly because they just can't afford to see a doctor early on.

      •  I'm pretty sure somebody would (3+ / 0-)

        have a breakdown on late detection owing to poverty or lack of coverage.  It's not just cancers, either, is it?  Nor is it just lack of coverage.

        As you say, cancer sister, you can manage alright this year, but you had to think about it, didn't you?  And what about next year, and the one afterwards?  You're in so much deeper than I am, given that it's chronic.  (My heart goes out to you).  

        But it shouldn't have to be this way.  Damn, Sam, the biggest difficulty Canada encountered when it brought in public health care was the flight of some specialists to the U.S.  Many of those, however, though not all.  Those who stayed abroad got replaced.

        If the U.S. goes public, there will be doctors who don't like it.  So?  Where are they going to go?

        If Canada can do it by fiat, then so, too, can the good old US of A.

        •  Agreed. If Canada can do it by fiat, so can we. (3+ / 0-)
          Recommended by:
          SarahLee, Schwede, oxon

          The current system we have in the US is nutty beyond all comprehension.  Who in the US doesn't have a surreal health-care story or know someone who's been pushed to the wall by an insurance or health-care cost catastrophe?  

          Your mention of "specialist flight" reminds me how bizarre it is that our system values doctors very highly in terms of what they're paid, yet nurses and other care workers matter just as much to patient health and survival and their compensation rarely comes up as an issue.  Defenders of the status quo never factor into their arguments that we have to increase nurse or PA or other care workers' salaries in order to ensure high quality of medical care.

    •  Dr. A has done a great job (0+ / 0-)

      examining the pros and cons of different health care systems in other countries.  I found them quite interesting and objective.  Canada sure looked good.

      49 Percent of Americans Unprepared to Pay For Medical Emergency
      World Health Care Tour I: The Top Down Approach
      Housekeeping  (not dusting and washing dishes)
      World Tour of Health Care II: In the Top Ten
      World Health Tour III: A Bottom Up Approach
      France Revisted
      World Tour IV: Viking Medicine
      The "Death by a 1000 Cuts" Bill

  •  Heart patient friend reached the "donut" in Aug. (5+ / 0-)

    so for rest of year she has no med support tied with Medicare Plan D.  I'm certain she's not unique for the drugs she takes are not unusual or rare. The crime is that when the patient most needs care, insurance is withdrawn.  

    Another friend's husband timed-out of Hospice care under VA plan, so he was sent home to die, within a month.  Again when the care was most needed, it was withdrawn.

    If this is happening in my own small circle of friends, imagine how much larger this is in the larger national scale.  If insurance continues to be  routinely withdrawn when catastropbic illness strikes, we would all be better off with a health care savings plan, for we will be paying the bills, anyway.  

  •  We have insurance, debt and pain (9+ / 0-)

    We have insurance. It went up more than we could afford so I took the higher deductible of $5,000. That's for each of us. We pay $800 a month. My husband has terrible back problems. We are in debt $9,000 - $4,000 from last year and $5,000 from this year.

    His doctor (we owe about $2,000 to him) will no longer make an appointment with him because we have been turned over to collections.

    So my husband continues in terrible pain and we still have to pay the $800 a month or we'd be uninsured. This is crazy.

    Single Payer The Healthy Solution

    by Arlyn on Sun Sep 02, 2007 at 03:44:11 PM PDT

    •  This is just wrong. And when I hear about people (5+ / 0-)
      Recommended by:
      nyceve, barbwires, mariva, Noor B, blue vertigo

      like Huckabuck{Huckabee} Talking as if people would just eat healty and maintain a normal weight and excerise, we wouldn't need Docs. and all this health care. I got sick out of the clear blue and I was a normal weight and excerised and ate healthy. People need single payer health care and they need it now. Anything less is just wrong. I am sorry about your husband and wish I could help, but I am drowning in my own debt.

      "Though the Mills of the Gods grind slowly,Yet they grind exceeding small."

      by Owllwoman on Sun Sep 02, 2007 at 03:52:26 PM PDT

      [ Parent ]

      •  That really p*ssed me off... (3+ / 0-)

        I was all of 15 years old, a non-smoking teen of normal weight in a time long before fast foods or processed foods.  My family ate lots and lots of fruits and vegetables.  Out of the blue I got UC (ulcertative colitis).  Like Crohn's it is an autoimmune chronic disease with no specific cause that comes on suddenly, and  that you live with forever or until they do surgery.  All my life I have been on medication for it and like other people with chronic diseases, I need testing yearly.  I have been one of the lucky ones.

        Many people with either UC or CD are unable to work.  So they have a debilitating disease, so bad they cannot work at all, and then have no insurance.  Even if they have the money for private insurance companies won't cover this kind of pre-existing condition.  So besides being sick, having no life, then they have the guilt of either being a burden on family or not being able to provide for family.

        I go to their board and my heart breaks for many of these people.  These diseases often hit people in their teens or twenties.  And insurance companies could care less that without maintenance drugs, life is beyond miserable.  

        I really hate the insurance companies...

        •  My daughter has Crohn's (1+ / 0-)
          Recommended by:

          I wrote about it on my  website

          All I can say is Hugs to you and I hope you are doing well.

          Single Payer The Healthy Solution

          by Arlyn on Sun Sep 02, 2007 at 05:01:17 PM PDT

          [ Parent ]

          •  I am doing very well (0+ / 0-)

            and thanks for caring.

            I hope your daughter is doing well.

            My worst years were in my twenties.  But I hung in there and the older I get the better....literally.  I still get colonoscopies yearly because of the increased risk of colon cancer.  

            But I do consider myself lucky to be so well at 61 years old and I hope the research leads to more and better meds for younger people.  
            Still good diet, exercise and a positive attitude helps a lot.

          •  Checked out your web site.. (0+ / 0-)

            and it is great.  I am very impressed and will go back and read some more.  Your daughter is lucky to have you.  I think one of the hardest things about IBD was the loneliness...and I honestly hope that now, with the  NET and the ability of kids to talk to other kids, it is a positive thing for their health.

            I remember when I was diagnosed in the dark ages in 1961, no one in my family heard of it. I felt like a freak.  I never met another person with IBD before 2000 when the husband of a family friend got it.  I used to envy kids with things like diabetes. I think it is great they have these camps for the kids, and they get to have people to talk to.  Don't get me wrong.  My parents, rest their souls, were great.  But they had no idea, neither had even graduated high school and even with decent insurance it was hard on them (but I never knew til years later).

            I have donated through CCFA. And I will continue to do so.

            Keep up the great work and support.

          •  Hugs to you and your daughter (0+ / 0-)

            I was diagnosed with Crohn's about 6 years ago; it's no picnic.

            After insurance, my 10-day hospital stay was still incredibly expensive.  Luckily I had family willing to pitch in and help.

            I cannot recommend highly enough the book "Listen to Your Gut" by Jini Thompson.  I followed it and was actually able to get off of meds completely -- I don't know if others have had the same results, but thought I would share the info in case it was helpful.


            "Strange women lying in ponds distributing swords is no basis for a system of government!"

            by ClickerMel on Sun Sep 02, 2007 at 10:07:17 PM PDT

            [ Parent ]

  •  How do we make... (3+ / 0-)
    Recommended by:
    joanneleon, midwife zora, Noor B

    ...a contribution to Jane?

  •  nyceve, I read in one of your comments above.. (2+ / 0-)
    Recommended by:
    Gustavo, nyceve

    "The whole thing" stinks, or something like that...As you know, and it's important to remind everyone, there are exceptions, wonderfully successful exceptions, within the US and in  other countries...

    My husband recently completed a cancer event. Diagnosed last Nov. and today, a dozen doctors later, surgery, meds, and he's cured. Cost? Monthly premiums are expensive, $950, but that's it. No copays, but more importantly no denials, no hesitation, no blood test or x-ray spared, full service, perfect outcome...a non-profit HMO.

    Why is that important? Because, it means that the status quo for most Americans - misery and loss from being uninsured, underinsured, or from junk insurance - is proven to be an unnecessary, overpriced, intolerable burden for people and businesses that has been chosen, is not the only option, and can be easily changed. We know we are asking for an achievable, affordable goal, a long way short of going to the moon.

    All Americans deserve the peace of mind of reliable health care with a proven track record of success, cradle to grave, unrelated to employment status, wealth, or clinical utilization. Equal access to health care and our clinical treatments should not be related in any way to the market penetration of the few good options or our ability to pay. Never. That is not a winning strategy, not even a win-lose, but a total loss. Even ins cos staff get sick...

    Still uncommitted, undecided...enjoying the dates; not ready for the ring or uhaul.

    by kck on Sun Sep 02, 2007 at 04:09:55 PM PDT

    •  yes (1+ / 0-)
      Recommended by:

      When my first husband was diagnosed with non-Hodgkin's Lymphoma in 1995, we had HealthAmerica as our HMO.  He was 31 and I was 25 and we had just picked a health plan from the choice of 3--no real thought to it.

      $400K in chemo 6 months later and zero copays, zero bills later, we were grateful.

      I now have HMO Blue here in MA and it's been great overall for our family; I have fibromyalgia, arthritis, and thyroid issues at 37, my 42 yo husband has Celiac and Crohn's, and our 8 yo son has Tourette Syndrome and sensory issues.  So far nothing's been rejected for coverage in years.

      I would still jump at national healthcare.

      Proud liberal, secular homeschooler.

      by mbzoltan on Sun Sep 02, 2007 at 08:19:26 PM PDT

      [ Parent ]

  •  The 'Moral Hazard' fallacy is the problem. (7+ / 0-)

    For-profit health insurance and scams like medical savings accounts are based on the totally false theory of moral hazard. This claims that individuals will wastefully consume more care if someone else is footing the bill. The absurd corollary is that forcing patients to pay a large share of their medical cost will 'incentivize' them to become more efficient in their use of medical services. This has been repeatedly proven false by well conducted studies. Patients will indeed reduce their short-term health expenditures if they are responsible for more of the cost. But they forego critical items like screening colonoscopy, hypertension control or mammography as well as the boutique items like cosmetic surgery, leading to greater illness and cost down the road.

    Bush's attempt to scuttle S-CHIP is totally consistent with a philosophical view holding that medical care is a waste of resources, and that forcing people to pay through the nose for high-deductible insurance is the best way to reduce medical costs. Ironically enough, the wealthy wingnuts who push these ideas tend to have fabulous first-dollar coverage provided by the taxpayers or by their shareholders.

    Evidently paying for medical care is only for the little people...pace Leona Helmsley.

    •  Oh God Yes! I HATE that theory. (0+ / 0-)

      And I hear it plenty in my program. It's a typical Ivory Tower pronouncement on how people live, if it wasn't so sorry It would be funny. Even the name shows how biased the person who came up with the theory was. I've argued and argued with our departments' economist that this effect is very small. Most people only try to obtain the health care that they believe that they need, and for someone to think people are out there getting all kinds of care that is not warrented is ridiculous. Maybe this works for plastic surgery and Botox, but it sure as hell doesn't work for pnuemonia or hypertension. I also argue that most sick people don't want to spend time doing all kinds of price sensitivity analysis on their proposed care, patients want to trust their provider to do what is right for their care.

      I'm not ready to make nice, I'm not ready to back down, I'm still mad as hell... Dixie Chicks

      by UndercoverRxer on Sun Sep 02, 2007 at 08:49:18 PM PDT

      [ Parent ]

  •  Kucinich Pushing Medicare For All (4+ / 0-)
    Recommended by:
    tmo, nyceve, Noisy Democrat, mcartri

    I read nyceve regularly because her insights and information about medical insurance is valuable.

    However, her last statement in this post is:

       "Why are all of the Democratic presidential candidates demanding that the American people re-board the Titanic?"

    That deserves a correction.  Dennis Kucinich is running for President and part of his platform is Medicare For All.  He is a co-sponsor of HR 676, introduced by John Conyers, which creates a single payer medical insurance system where the government pays the bills.  

    I will grant that it is unlikely that Kucinich will become President.

    •  Thanks, ammasdarling . . . (1+ / 0-)
      Recommended by:
      Noisy Democrat

      I goofed, I'll fix it.

      Appreciate the correction. Now I feel like an idiot.

    •  There is also HR 1200 (0+ / 0-)

      the American Health Security Act:

      (a) In General- Subject to the succeeding provisions of this title, individuals enrolled for benefits under this Act are entitled to have payment made under a State health security program for the following items and services if medically necessary or appropriate for the maintenance of health or for the diagnosis, treatment, or rehabilitation of a health condition:

      (1) HOSPITAL SERVICES- Inpatient and outpatient hospital care, including 24-hour-a-day emergency services.

      (2) PROFESSIONAL SERVICES- Professional services of health care practitioners authorized to provide health care services under State law, including patient education and training in self-management techniques.

      (3) COMMUNITY-BASED PRIMARY HEALTH SERVICES- Community-based primary health services (as defined in section 202(a)).

      (4) PREVENTIVE SERVICES- Preventive services (as defined in section 202(b)).


      (A) Nursing facility services.

      (B) Home health services.

      (C) Home and community-based long-term care services (as defined in section 202(c)) for individuals described in section 203(a).

      (D) Hospice care.

      (E) Services in intermediate care facilities for individuals with mental retardation.


      (A) Outpatient prescription drugs and biologics, as specified by the Board consistent with section 615.

      (B) Insulin.

      (C) Medical foods (as defined in section 202(e)).

      (7) DENTAL SERVICES- Dental services (as defined in section 202(h)).

      (8) MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT SERVICES- Mental health and substance abuse treatment services (as defined in section 202(f)).

      (9) DIAGNOSTIC TESTS- Diagnostic tests.


      (A) OUTPATIENT THERAPY- Outpatient physical therapy services, outpatient speech pathology services, and outpatient occupational therapy services in all settings.

      (B) DURABLE MEDICAL EQUIPMENT- Durable medical equipment.

      (C) HOME DIALYSIS- Home dialysis supplies and equipment.

      (D) AMBULANCE- Emergency ambulance service.

      (E) PROSTHETIC DEVICES- Prosthetic devices, including replacements of such devices.

      (F) ADDITIONAL ITEMS AND SERVICES- Such other medical or health care items or services as the Board may specify.

      (a) No Balance Billing- Payments for benefits under this Act shall constitute payment in full for such benefits and the entity furnishing an item or service for which payment is made under this Act shall accept such payment as payment in full for the item or service and may not accept any payment or impose any charge for any such item or service other than accepting payment from the State health security program in accordance with this Act.

      (b) Enforcement- If an entity knowingly and willfully bills for an item or service or accepts payment in violation of subsection (a), the Board may apply sanctions against the entity in the same manner as sanctions could have been imposed under section 1842(j)(2) of the Social Security Act for a violation of section 1842(j)(1) of such Act. Such sanctions are in addition to any sanctions that a State may impose under its State health security program.

      (a) Establishment of List-

      (1) IN GENERAL- The Board shall establish a list of approved prescription drugs and biologicals that the Board determines are necessary for the maintenance or restoration of health or of employability or self-management and eligible for coverage under this Act.

      (2) EXCLUSIONS- The Board may exclude reimbursement under this Act for ineffective, unsafe, or over-priced products where better alternatives are determined to be available.

      (b) Prices- For each such listed prescription drug or biological covered under this Act, for insulin, and for medical foods, the Board shall from time to time determine a product price or prices which shall constitute the maximum to be recognized under this Act as the cost of a drug to a provider thereof. The Board may conduct negotiations, on behalf of State health security programs, with product manufacturers and distributors in determining the applicable product price or prices.



      [8.7 percent]


      [2.2 percent of the taxable income of the taxpayer for the taxable year]


      HR 1200 is the bill mostly to become Federal law in my opinion.

  •  is there an analogy with pension plans? (0+ / 0-)

    What I mean is that many large companies have defaulted on pension plans by either declaring bankruptcy, or in some cases, by selling the company without passing on the obligations.

    I'm quite cynical---I believe that the gouging of the middle class was a plan of the Bush administration from the beginning. The goal is to destroy the political power of the middle class by taking away their security, thereby forcing them to work so hard they won't be able to mobilize politically.

  •  I love your diaries, nyceve. (4+ / 0-)

    I am a physician (pediatrician) and I too despair at the state of the health care system in America.  I agree that health care costs are out of control, but I hope people will remember (as you have pointed out many times in prior diaries) that a huge portion of each health care dollar in America goes to administrative costs and insurance company profit.  Although health care costs are skyrocketing, the providers can't be blamed for much of that.

    I can't quote statistics or studies, I can only relate my personal experience.  I work in a multi-specialty group (about 50 doctors) located in a small town with one hospital.  In the five years that I've been with this clinic, the number of patients I've seen has increased dramatically every year, but my salary (which is based on the clinic's profit) hasn't gone up a bit.  Management tells us that Medicare and Medicaid reimbursement rates have been cut repeatedly, and the private insurance reimbursement rates have been cut as well (many of them agree to pay a certain percentage above the Medicare rate).  Also, health insurance for our employees is just about our biggest expense, and it has gone up and up.  We have had to raise co-pay's and deductibles every year, and we still pay quite a lot for our coverage.  In fact, most of our clerical employees' children are eligible for Medicaid, so they don't even bother to pay for our expensive insurance.  (Don't even get me started about how poorly we pay our employees--many only make barely above minimum wage.)  

    Many of the older physicians are becoming discouraged and electing to take early retirement.  There is a philisophical debate going on now about whether we will be able to survive as an entity over the next few years.

    Personally, I would welcome a single-payer system.  I think the profit motive needs to come out of the health care system entirely, but that is surely a pipe-dream in America.  The interesting thing is, I hear more and more staunchly conservative, republican physicans admitting that change is more than past due.  I'm hoping that the increasing dissatisfaction of Americans with the current system will eventually provide the momentum for change.

  •  I saw this on FDL yesterday--SiCKO come to life (1+ / 0-)
    Recommended by:

    we know and love and respect Jane and are all rooting for her, but the really sad part is that she is not alone.

    Politics is like driving. To go backward, put it in R. To go forward, put it in D.

    by TrueBlueMajority on Sun Sep 02, 2007 at 06:58:40 PM PDT

  •  We've been turned into serfs. (3+ / 0-)
    Recommended by:
    SarahLee, UndercoverRxer, junta0201

    However, in the past, the slave-masters would provide health care for their slaves, just as a farmer provides veterinary care for his animals.  Now, the noblesse-oblige has been discarded, we've been discarded to the wolves.  Anyone not being able to make is told it's their own fault, not working hard enough, not enough schooling, whatever handy excuse.
    Another swindle is housing prices, workers being swindled out of their future life earnings for overpriced housing.

    My son just finished a hitch hiking tour across the country.  In one locale, his tent was confiscated by law enforcement, I had to bail it out for $35.  Another locale, he was greeted by
    "garden hose alarm clock", when he pitched his tent in a public place.  Good Lord, it is time for a full scale revolt.
    The masters need a good public execution or three as in French Revolution style.  Time to teach clueless George a lesson he can understand, and not "My Pet Goat".

  •  Reading through all these comments (0+ / 0-)

    just breaks my heart.  I can't imagine living with the stress and the worry of not having all my medical expenses paid.  As a Canadian, I don't even have to think twice about seeing my doctor, or worry about my elderly parents who are both battling cancer and getting good medical care on an almost daily basis.  Yes, our taxes are higher but nothing like the $800-900 a month your health insurance costs you.  Yes, there might be waiting lists for non-emergency treatment, for elective surgeries, but I know that if I ever need urgent care, it's provided without question.  I personally have never run into a problem of having to wait for specialists or procedures but I do hear stories of people having to wait a few months for, say, knee replacement surgeries.  But they all get them, at no out of pocket cost to themselves.  It's hard to believe that such a progressive country as the U.S. is so far behind in looking after their own citizens.

  •  health insurance (0+ / 0-)

    As usual Eve, out of the park.
    I thought insurance was supposed to give you some peace of mind at a time of need-think homeowners or auto insurance.Instead this "heatlth insurance" is just a way to rob Americans of their hard earned money. CEOs of health insurances companies need multi billion dollar salaries to keep up with the other bloodsucking CEOs in this country, don't you know.
    I left a job recently with pretty good benefits so I can be closer to my elderly mom who is not doing so well but her Kaiser coverage is pretty good: inexpensive copays, a pretty good primary care doctor, good specialists. She can go on for the rest of her life without worrying about the cost of her medical expenses. Why do you have to over 65 to have good insurance in this country? And which one of these lying motherfuckin politicians does without his or her gov't paid health plan, the kind the rest of the hoi polloi can only dream about.
    This new job offers some PPO plan but it doesn't look like much. Am flirting with the idea of going without and if I get sick...I could not even afford the copays.
    I guess this is  the new America. Omly the haves and have mores need survive.

    What do we want? Universal health care! When do we want it? Now!

    by cagernant on Sun Sep 02, 2007 at 08:47:18 PM PDT

  •  Jane and cancer (1+ / 0-)
    Recommended by:

    Sorry. In my last post I was doing it while watching the Simpsons and did not get to address Jane and her battle with the Big C.
    Jane, if you live in the LA area I would be honored to provide nursing services if you need them. My email is
    I'll be praying every thing goes allright.
    I wonder if Tony Snow is dealing with copays, preauths, denials, etc.

    What do we want? Universal health care! When do we want it? Now!

    by cagernant on Sun Sep 02, 2007 at 08:59:07 PM PDT

  •  This doesn't surprise me (1+ / 0-)
    Recommended by:

    This is similar to the student loan industry, which has profited immensely from laws making it all but legally impossible to discharge those debts in a bankruptcy proceeding. They have been able to make more money from delinquent loans than from those who pay on time.

    Of course the medical debt collection agency business is going to boom. Doctors, hospitals, and other healthc-care facilities will sell the debts for pennies on the dollars to these firms. For example, if they sell a $1000 unpaid medical debt for .03 on the dollar, that collection agency pays only $30. If they are able to get the delinquent debtor to pay $300 of the $1000 that is owed, that firm makes a profit that is 10 times as much as what they paid for the debt.

    So it doesn't surprise me that collection agencies have decided to start buying delinquent medical debt. It is a guaranteed profit-making venture for them.

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